ADHD or Hypervigilance?

If you’ve read my blog for some time, you know The Princess is going through, and dealing with, a LOT of trauma stuff these days.  She is diagnosed with PTSD (post-traumatic stress disorder), anxiety, attachment issues, and ADHD (Attention Deficit/Hyperactivity Disorder) – emphasis on the H!  It’s never dull around here, and I am quite literally EXHAUSTED from it all.  Lately, my patience is so thin, and my therapeutic parenting tool box is so scattered about my brain, that when I need one of those therapeutic tools, I really have to root around my head to find it.  This is especially true when we’re out in public.

Last night at Applebees, The Princess was as animated as a 3-year-old on steroids that were washed down with a 2-liter bottle of Mountain Dew.  She was like that going into the restaurant.  She was like that all through the meal.  She was like that when we left, as she bounced backwards into two people coming into the restaurant while we were going out.  She was like that when she ran out into the parking lot, in the dark, in front of a car driving way too fast for a restaurant parking lot.  (Thankfully, Hubby grabbed her.)  She was also like that as we were getting into the car -- until I yelled at her, “I.  have.  had.  E-NOUGH!”  (No, this is not a therapeutic parenting technique.)  Strangely, I think it shocked her because she stopped, doe-eyed in her tracks.  Still, the shock broke the craziness and she was (mostly) quiet on the ride home.

I’m sure most people who witnessed The Princess’ behavior last night would have either agreed with her ADHD diagnosis or thought we were “those kind” of parents  -- the ones who allow their children to behave poorly.  (For the record, I am not one of “those” parents.  I am a “mean mommy,” and I am proud of it.)  The thing is, when it comes to that ADHD diagnosis, I’m not so sure all the craziness The Princess displays in public is due to hyperactivity as much as it’s due to hypervigilance.

The next time we go out (and it won’t be any time soon), I will spend some time preparing The Princess for our family time.  She needs to be reminded she’s safe.  She needs to be reminded she’s a big girl.  She even needs to be reminded that she will be protected and not abandoned.  We will take care of her.

ADHD is the most commonly diagnosed disorder in adopted children.  Articles I’ve read suggest children diagnosed with ADHD often have a biological parent (usually the father) with ADHD.  Research suggests  environmental factors also play a significant part, including prenatal exposure to alcohol and drugs, a mother’s smoking while pregnant, and low birth weight.  Lead poisoning also seems to play a role in a great number of children diagnosed with ADHD.  Kids coming from orphanage backgrounds, like my kids, are even more likely to be diagnosed with ADHD. 

However, I’ve also read some adopted, hurt kids diagnosed with ADHD may actually be hypervigilant due to past trauma.  There’s an article on Boris Gindis’ website here that explains this observation.  The more I watch my daughter and get to know her, the more I believe she is hypervigilant more than ADHD.  She is able to focus and settle down when she is motivated to do so.  She loves to read books for long periods of time.  She can sit still when she feels safe.

The things that make her seem hyperactive include the behaviors she displayed last night at dinner.  When I yelled, she snapped out of it.  I believe she was still hypervigilant after I yelled; her behavior just changed because she was afraid of my reaction.  As my kids have gotten older and have begun to try to reason (even if they’re often not all that successful at it), I can see how “snapping them out of it” works sometimes. 

Now, I’m NOT saying the WAY to do that is to yell.  However, I am saying a little bit of understanding of how others perceive your behavior isn’t such a bad thing.  Some may call it “shaming.”  I call it “awareness.”  If my child is stuck in asinine, annoying, anti-social behaviors, she needs to be made aware those behaviors are unacceptable.  Sometimes, that awareness needs to happen sharply and quickly.  Otherwise, you’re paying for an ER visit for some poor guy who just wanted to have a nice dinner with his wife, or you’re scraping your kid off the macadam. 

Still sometimes, I think it’s all just a crap shoot.  What works one time doesn't work the next and I'm always trying to figure something else out to do.

Sudden “awareness” can sometimes trigger hurt kids into full out rages.  This happened with The Princess at the zoo back in December.  Thankfully, this is very rare for her.  (A public, full-on rage has never yet happened with Youngest Son.)  Usually, “awareness” works to stop extreme animation in The Princess.  Some may say, “Yeah, but you pay for it later.”  I’m not so sure I wouldn’t be dealing with something later anyhow.  If it gives me a relatively quiet ride home after a dinner that four out of the five of us did not enjoy because The Princess was the star attraction of the Applebees’ Review that night, then I’ll take it.

Black & White Thinking

Riding in the car on the way to school this morning, my daughter asked, “Mom, what is human trafficking?”  Talk about a sucker punch. 

My daughter is processing SO MUCH lately.  Hard topics such as human trafficking are not something I was prepared to deal with today, alongside known trauma triggers such as bio-family stuff like I wrote about on Friday, bad dreams like I wrote about HERE recently, or acting out behaviors like at the zoo over the holidays.  Heck, I wasn’t even fully awake yet.  I am NOT a morning person.  So, what did I do?  I took a big breath.  I let it out.  Then, I answered her with a question of my own.  “Honey, were you talking about human trafficking in youth group last night?” 

Well, yes.  It was THE topic of discussion last night.

Another deep breath in.  Another deep breath out.

I kept driving.  I gave her a broad definition of what human trafficking meant.  She asked a few more questions.  She told me some more things her small group leader told her about the topic.  I told her that yes, those things were sadly true.  Then I said I wished the youth leaders told parents when they were going to be dealing with such hard topics.  She said, “Me, too.” 

Then she asked, “What about alcoholics?”  I asked in return, “What about them?”  She rolled her eyes and told me that she is probably going to be an alcoholic, as well as poor, when she grows up.  I asked her why she thought that and she said it was because they discussed it in Sunday School yesterday.  She said that “people who grow up with alcoholic parents become alcoholics, and people who grow up poor stay poor.”  Whether it was discussed QUITE that way or not, I don’t know, but I do know she was triggered by the discussion.  So was Youngest Son.  He confirmed that this was the discussion.

Unfortunately, not enough people working with traumatized kids know enough about them or their needs.  More training is needed – really needed – for anyone working with children.  This education should be part of any teacher training, youth & children’s ministry training, or sports/recreation training.  We trauma mamas need to figure out a way to make this happen!

Traumatized kids tend to see things as black and white.  There are no gray areas.  It doesn’t matter if they’re 6 or 16.  Something either is, or it isn’t.  They think, “If I had alcoholic parents, I will be an alcoholic.”  That’s a traumatized brain.  There are no gray areas that say, “I HAD alcoholic parents, but now I’m being raised in a safe, functional family and I can overcome my past.  I can learn skills that will help me navigate life in a more healthy way.”  Likewise, even though they’ve been told many times, there is no ability to remember that God is in the business of redemption when our kids are triggered.

Black and white, or “all or nothing” thinking, is tied to the most primitive of human responses:  flight or fight.  Kids dealing with complex trauma, when triggered, are transported back to that primitive state of being in flight or fight mode, just as they were when the trauma first occurred.  It is an automatic response on a very basic level.  There is no rationalization.  The brain in flight or fight mode cannot rationalize.  It reacts.  Because traumatized kids are triggered to believe their lives are in danger – that they may actually DIE -- there is no time for “if this” or “maybe that.”  There is no room for gray.  While a youth worker discussing social problems with the youth group may also discuss the redemption of God, or the ability to overcome hard beginnings with good nurturing, the brain of a traumatized kid already in flight or fight mode simply will not process this.  There is no time for uncertainty when your life is threatened.  You need to decide whether to run, or to stay and fight.

The amygdala, which is in the middle part of the brain, and the center for the fight/flight/freeze response, is fully functional at birth.  That means that even a tiny baby is capable of a full blown trauma response.  Even children who do not cognitively remember a traumatic event can still have that full blown trauma response stored in their amygdala.  It “rewires” the brain for life.  It does not go away with love and time.  It can be triggered by events, actions, discussions, sights, smells, touches, and sensory experiences in the future.

The hippocampuses, where the brain assesses stimuli and tells us whether or not it is threatening, is not fully functional until a child is about five years old.  The cortex – the front part of the brain where we can think and figure things out and rationalize -- is not fully mature until around age 12, sometimes even older. This means that when a baby or young child is hurt and frightened, they have no way of understanding what is going on around them. The front part of their brain can’t rationalize what’s happening, so the middle part of their brain simply stores the trauma.  That trauma causes black and white thinking (a flight or fight response), because they do not have the developmental capability to process levels of threat, nor the cognitive capability to even understand what’s happening.

Kids dealing with complex trauma CANNOT simply “get over it.”

The result of trauma triggers such as hearing, “people who grew up with alcoholic parents become alcoholics” is too often a self-fulfilling prophecy.  In traumatized kids’ all or nothing thinking, they believe they are doomed to repeat their biological parents mistakes.  They believe they are destined to BE their biological parents.  Their already too well-established sense of being “damaged goods” is reinforced.  In their black and white thinking, their beliefs about themselves are affirmed.  The instruction of a well-meaning teacher or youth worker is twisted to a belief that is exactly opposite of what any caring adult would intend.

In addition to education for people working with youth and children, parent notification is also essential when hard topics will be presented in the classroom or the youth meeting.  Youth leaders and teachers should notify parents IN ADVANCE that they will be discussing hard topics with youth.  Parents raising hurt children can then decide how best to prepare their child for the topic – or even whether or not to allow their child to participate in that discussion at all.  Some parents may decide to prepare their child and also attend the session with the child.  Still, the decision on how to best approach these topics with a traumatized child should be left up to the parent.  Communication is the key.  Teachers and youth workers should not depend upon children to communicate to parents that a hard topic is to be discussed, or that a documentary on a hard topic will be shown.  One of the greatest challenges for parents of traumatized children is getting them to tell us anything!  Adults need to communicate with adults.  As parents, we are the ones who need to take the initiative.

As parents, we need to be the ones talking to our kids’ teachers, youth leaders, and coaches.  We need to be proactive, and not reactive (often the “fight” of flight or fight response) ourselves.  Communicate with the adults in your child’s life.  Perhaps offer some training.  The FACT SHEETS I posted on this blog are a good tool and can be adjusted to help youth leaders outside the classroom as well as for teachers.  There are also some good resources posted HERE.  Feel free to share in the comments section additional resources or links to sites you have found helpful.

Bio-Family Stuff

As I wrote yesterday, The Princess is processing a lot of “stuff” right now.  She’s dealing with a lot of memories – both real and imagined – and she’s trying to figure things out to make sense of them.  We are trying to help her do that with attachment and family therapy, based on a combination of research and techniques used by folks such as Dr. Bruce Perry, Dr. Becky Bailey, and Heather Forbes, LCSW.  Princess wants to bury her feelings about this “stuff” and deal with things on her own terms – terms which are just not healthy, and cause her to act out with much anger and resentment.  Interestingly enough, however, she is still talking to me – still asking questions.  On her own terms.  In her own time.  I’m realizing I’m not always as ready for “it” as I thought I would be.  Last evening was one of those times.

The Princess started asking questions about her bio-family and past traumatic events.  Her memory of these things is skewed because she was so little, and because Youngest Son feeds her his own skewed memory of the events.  My practice has always been to set them both straight – to tell them the truth I know.  I share what information we have in court documents.  I also tell them the things their paternal grandmother told us when we did biological family research (through an in-country facilitator) a few years ago.  At first, I thought it was best to “protect” the kids from the details.  Who wants to tell their children the woman who gave birth to them did the things she did?  Who wants to hear their birth father’s depression was exponentially fueled by the actions of their birth mother, and the alcoholism of them both?  This stuff was just too hard.  I didn’t want to talk with them about it.  The Princess, however, while she is very immature emotionally, is also very, very smart.  On one hand, she doesn’t want to know, but on the other, she does.  She has questions about her story.  Afterall, it’s HER story.

Processing her story is something I want her to do with me in therapy.  Unfortunately, she tends to process a lot of it at school with friends.  Most of these friends are hurt kids themselves.  She’s attracted to them like a fly is to poo.  (Yeah, I made that analogy on purpose.)  I do not like that this is true for my daughter.  I do not like that trauma too often begets trauma – or, at least, feeds off it.

My daughter has copies of some of the pictures we received when we did that bio-family search.  These pictures are of her grandparents, aunts, uncles, cousins, and even her biological father.  She also has some pictures from her orphanage.  The deal was she could look at these and talk to us about them at home.  However, she has taken them to school on numerous occasions without my knowledge and has shown them around, telling these other hurt kids way too much – much more than any of them can handle.  Much more than she can handle on her own.  And they’ve hurt her more with their comments and questions.  (I wish I fully understood why hurt kids tend to set themselves up for more hurt.)  I have never given her the one picture I have of her birth mother.  I wasn’t planning on giving it to her, or even showing it to her, any time soon.  But I showed her last night. 

I don’t think I’ll ever get why some cultures take pictures of dead bodies at funerals.  I don’t think I’ll ever get why the mourners pose with the dead body and have their picture taken, too.  This is the one picture I have of the birth mother.  The family is gathered around the birth father’s open casket.  She is standing at the head of the casket with Youngest Son.  The Princess is not in the picture, and to our knowledge, she did not attend the funeral (though she insists she did even when Youngest Son tells her she did not).  While it is possible to crop the picture, the image of the birth mother’s face is very tiny.  She is looking down.  The sun is shining brightly on the right side of her face, whiting out a portion of her image.  It is not a good picture photographically at all.  Yet, it is the only picture I have, and The Princess wants it.  She wants me to print it out for her. 

I am not doing that.  Not now anyway.

In my head, I understand The Princess’ need to remember her birth mother and know what she looked like.  The Princess insisted she had blond hair prior to seeing the picture, for example.  She did not.  She has dark brown hair, just like The Princess.  My daughter also insisted that birth mother was thin.  She is not thin in this picture.  She is, in fact, a bit chubby.  I also get that my daughter needs to know WHO she comes from as well as where she comes from.  I get that.  That’s my own driving force in being a genealogy geek.  I learned my mother’s Dad was not her biological father when I was 15 years old.  I always wondered about that man and about the family I was a part of, but did not know.  I found them as an adult, but my mother and my grandmother kept all that information from me.  It wasn’t right.  It wasn’t fair.  Even if my biological grandfather treated my grandmother poorly, I still had a right to know about the PEOPLE I come from.  My daughter has that right, too.  Strangely though, I now understand my grandmother and mother’s resentment at my need to know. 

As we were preparing to adopt, I read all I could about the needs of adopted children to know about the people they come from.  I was sure I would be supportive and that I would never say an ill word about my children’s birthparents.  I would be positive.  I would help them learn what they wanted to learn.  I would even support them having a relationship with extended family members.  I was clueless.

I had no idea I could hate the birth mother of my children.  (Yep.  I said that, too.  I have hated her.)  It is SHE who did this to MY kids.  It is SHE who deserves my daughter’s wrath, though it is I who deal with it.  It was HER actions that have caused MY children so much pain.  Yes, I have hated her.  And I’ve secretly wished my children would hate her, too.

Hate is a cancer that eats your soul.  Trauma is drawn to trauma.  Hate is drawn to hate even more so.  I don’t want my children drawn to trauma.  I don’t want my children drawn to hate.  Therefore, I needed to let go of hate.  Sometimes, I will admit, that need resurfaces and the “let go” is moment-to-moment.  It is then I need to remember I cannot hate someone I’ve never known.  It is her decisions and her actions that I hate.  It is the sin (and yes, that’s the word) that I hate.  I do not hate the person.  (Admittedly, I do struggle to love her.)  She is not well.  She was not well when she hurt my kids.  My daughter wants to know who she is.  So, I will tell her the truth – again and again – however many times she needs to hear it.

I have still not printed out the picture for her.  I do not want it floating around a middle school.  There is one “friend” there that is particularly cruel to The Princess.  I do not want this “friend” having any more fuel for her twisted fires.  I also do not want other friends giving their 12 and 13 year-old opinions about it.  She’s already been made fun of this week for having an “old” mother (me).  I can still at least TRY to protect her from some things, can’t I?  (Oh, how homeschooling sounds better and better to me with each passing day.)

I love my daughter more than I can express in words.  She is MINE.  She comes from her. 

My daughter can look at my copy of the picture. 

We’ll print it out and take it to therapy next time.

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Added later:  On second thought, maybe I WON'T print out the picture and take it to therapy next time we go.  I hadn't thought about what to do with it afterward.  As Diana writes below, destroying it is probably not a good idea.  If I file it, I can guarantee both she and Youngest Son will be rooting through ALL my stuff trying to find it.  And leaving it with the therapist is probably something even my therapist wouldn't recommend.  Thanks Diana for sharing some things I hadn't thought about.  Like I said, sometimes I'm just not as prepared to deal with the "stuff" as I thought I would be.  It is on my computer (and backed up) in secure files.  Only I know the password.